General Practice

1. General Practice Role and experience as key providers of comprehensive health assessment for children and young people entering out-of-home care Sonya Tremellen & Dr Hubert Van Doorn

2. Why is primary care best placed? • GPs most readily accessible medically qualified professionals • GPs first point of entry in Australian health system & can identify needs & refer appropriately • GPs have medical skills to identify & manage breadth of health care needs across ages and stages • Attending GP clinic is normal, non-stigmatising experience

3. Are GPs ready and willing? – Research Findings • GPs not ready to undertake child health assessments without some changes in practice systems • GPs positive about potential benefits, but have ethical concerns • Epidemiology of child abuse and neglect not widely shared with general practice • GPs would welcome further training and professional development support • Links between the GP and child protection sector need improvement • GPs are wary of red-tape burden & medico-legal complications • Workforce and financial pressures have critical influence • GPs prefer health assessment to be a first step in an ongoing therapeutic relationship Webster SM, Temple-Smith M. (in press) Children and young people in out-of-home care: are GPs ready and willing to provide comprehensive health assessments for this vulnerable group? Australian Journal of Primary Health

4. 9 GP Advisors from across Victoria confirmed that: professional development module appropriate Commissioning letter from DHS required (along with medical history) Medical software template essential GP provides Summary Report & Recommendations $300 fee-for-service Require clarity re: consent for treatment Concern re: follow-up & continuity GP Engagement: Field testing

5. Workshops held September 2008 & March 2009

6. The pilot – process findings • General Practice successfully recruited • 2 month turn-around is achievable • Medical histories arrived • Children & young people knew what they were there for • GP assessment time: 45 + minutes (average) • Practice Nurse assessment time: 30 minutes (average) • GP Report time: 30 minutes + (average) • GPs satisfied with remuneration The number of referrals to GPs made by Child Protection much lower than expected (27 over 14 months) Of the 13 GPs trained, 6 received a referral

7. Health assessments n=24 6 (25%) children under-immunised 3 (12%) required treatment for acute illness Important health issues identified 20 (83%) required referral (15 different service types) • Paediatrician • Dentist • Renal Unit at Royal Children’s Hospital • Orthopaedic and Plastics Unit at Royal Children’s Hospital • Back X ray • Wellbeing Coordinator at school • Hepatitis C Screening test • Optometry • Audiology • Psychologist • Family Planning/sexual health • Podiatry • Educational support required for literacy and numeracy • Hepatitis B immunisation • Speech therapist

8. Who does what? PN and GP roles Nurses: • set up appointments & entered medical history into General Practice medical record • Checked immunisation, height, weight & some did more GPs: • Established rapport • Comprehensive physical & behavioural examination • Practices work it out • Team work

9. Focus Group discussion • Recognised complexity of client group and time required for thorough assessment • Highly valued the opportunity to participate given evident benefits to children & young people • Demonstrated the role of the practice nurse and value of teamwork in the practice • Identified effective ways to manage the consultation • Organisational issues • Concerns re: Follow-up

10. Addressing enduring concerns • Initiate and sustain GP engagement – work through GP organisations • Strengthen the link between health and child protection sectors • Support clinical governance and continuity of care

11. Questions Final report available from: www.gpv.org.au Contacts: Sonya Tremellen s.tremellen@gpv.org.au 03 9341 5205